The Childrens Clinic, PLLC.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

39507 Issued in KY

Legal business name

THE CHILDRENS CLINIC, PLLC.

Practice address

420 Loretta Road
Lebanon, KY 40033

Phone

(270) 699-2210

Fax

(270) 699-4335

NPI assigned

Jan 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Max Gucilatar, M.D.

Title

Owner

Phone

(270) 699-2210

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669523684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 LORETTA ROAD",
            "city": "LEBANON",
            "state": "KY",
            "postal_code": "40033",
            "telephone_number": "270-699-2210",
            "fax_number": "270-699-4335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 LORETTA ROAD",
            "city": "LEBANON",
            "state": "KY",
            "postal_code": "40033",
            "telephone_number": "270-699-2210",
            "fax_number": "270-699-4335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CHILDRENS CLINIC, PLLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GUCILATAR",
        "authorized_official_first_name": "MAX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-699-2210",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "39507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Lebanon, KY
• Providers in Lebanon, KY by specialty
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.